Wednesday, June 17, 2015

David Tredinnick – Quack Candidate for Health Select Committee Chair

Today the UK Parliament will have a vote for the chair of the Health Select Committee. The two choices could not be more starkly different, so much so that this vote might be seen as a referendum on two world views, one that respects science and another that confuses pseudoscience and spirituality for medicine.

On one side we have Sarah Wollaston, the previous chair, who is a former general practitioner and has taken a solid stand against pseudoscience in medicine. She has previously tweeted, for example, “#Homeopathy can also have serious harms when masquerading as a ‘vaccine’.”

Tredinnick, on the other hand, has previously argued that the NHS should incorporate astrology into the healthcare system. I have previously argued that homeopathy is the most absurd and easily debunked major form of alternative medicine. Astrology, however, is arguably more absurd, I just never heard it offered as a basis for healthcare. Tredinnick has at least accomplished setting a new low bar for alternative medicine nonsense.

Tredinnick appears to be a true-believer, fully steeped in the propaganda that is CAM (so-called complementary and alternative medicine). He has said:

“Ninety per cent of pregnant French women use homeopathy. Astrology is a useful diagnostic tool enabling us to see strengths and weaknesses via the birth chart.

“And, yes, I have helped fellow MPs. I do foresee that one day astrology will have a role to play in healthcare.”

That is frightening enough, but he goes on to say of his critics:

Opposition to astrology is driven by “superstition, ignorance and prejudice”, he said. “It tends to be based on superstition, with scientists reacting emotionally, which is always a great irony.

“They are also ignorant, because they never study the subject and just say that it is all to do with what appears in the newspapers, which it is not, and they are deeply prejudiced, and racially prejudiced, which is troubling.”

You need to have a profound level of scientific illiteracy to hold such opinions. These statements also represent irony of epic proportions. Astrology, of course, is nothing but superstition, and is steeped in scientific ignorance. Scientists are dismissive of astrology because it is patent nonsense, not because they do not understand it. There is no possible way for the apparent alignment of stars and planets as subjectively viewed from earth to affect the personality or fates of people on earth. Astrologers have also had a couple thousand years to make their case, and have failed to do so. There is simply nothing there but pre-scientific superstition.

It is also interesting that Tredinnick thinks dismissing astrology is “racially prejudiced.” I wonder what race he is talking about. Actually, he did clarify this in a 2009 statement in which he wrote:

I am talking about a long-standing discipline-an art and a science-that has been with us since ancient Egyptian, Roman, Babylonian and Assyrian times. It is part of the Chinese, Muslim and Hindu cultures. Criticism is deeply offensive to those cultures, and I have a Muslim college in my constituency.

The Babylonians might find it offensive also. Is Tredinnick aware that these ancient astrological systems are mutually incompatible with each other? So which astrological system should the UK health service use? I would argue that it is offensive to these modern people to argue that their culture is based upon superstition and pseudoscience.

Across the world in some of the largest populated countries like India and China patients are routinely treated with therapies like homeopathy, herbal medicine and acupuncture alongside orthodox Western medicine. This provides a more rounded treatment plan and brings about better patient outcomes in combining the best of what both philosophies have to offer.

He offers this as evidence that CAM is being integrated into “orthodox” medicine. However, these are examples of modern medicine being incorporated into areas that previously relied upon pre-scientific healthcare methods.

You will also note that he refers to both as “philosophies.” This is a clue that he is well-read in pro-CAM propaganda, which largely advocates philosophy-based (rather than science-based) medicine. He is trying to subtly argue that science-based medicine is just another philosophy, and thereby put CAM on an equal footing. This is a similar strategy to what creationists use, arguing that the evolutionary “model” is just another “faith,” and therefore on equal footing with the creationist “model.” They both make clever use of language in an attempt to create a false equivalency, and gloss over the fact that one (modern medicine and evolutionary theory) is legitimate science and the other (CAM and creationism) is pseudoscience.

He then makes two statements that directly contradict each other:

Some people think that all complementary therapies should be available on the NHS, some people think none should, and some believe, as I do, that we need to determine what works for what conditions and provide those treatments for patients. We cannot get bogged down with demands for randomised controlled trial (RCT) evidence, as some do.

Tredinnick wants to separate what works from what doesn’t work, but doesn’t want to get “bogged down” in actual evidence. I do have to say, he captures the essence of CAM quite well. Of course, if you do research to identify what works and for what conditions then you are not doing CAM, you are doing regular medicine. CAM proponents are in a difficult ideological position. They desire the mantle of legitimacy, which means claiming to be evidence-based. However, scientific evidence has already shown that their main treatments (homeopathy, acupuncture, energy medicine) do not work. They need to have it both ways, so what do they do?

First, they misrepresent the evidence. Tredinnick wrote previously:

“Attacks have also been made on the efficacy of homeopathy. A letter was sent to the World Health Organisation warning against the use of homeopathy, but it ignored the very clear randomised, double-blind trials that proved that it is effective in the particular area of childhood diarrhoea on which it was criticised.”

You see that CAM proponents are happy to cite double-blind placebo controlled trials when they think it supports their side, then criticize them as closed-minded when the results are negative. Further, the evidence for the efficacy of homeopathy for diarrhea is negative. Tredinnick, like other homeopathy advocates, is cherry picking one review of a few studies, ignoring other reviews which found the evidence negative, and a later larger trial that was clearly negative. This is a great example of not understanding (or caring) how to properly evaluate clinical evidence. As with homeopathy for any indication, there is no evidence showing a clear effect that can be replicated. There is only inconsistent marginal evidence. Cherry picking, however, can put lipstick on any pig, no matter how ugly (with appropriate apologies to our porcine friends).

If Tredinnick wants evidence, but not pesky double-blind studies that have a frustrating tendency to be negative with regard to his preferred treatments, what kind of evidence does Tredinnick want? He tells us:

It is hypocrisy by many who demand it, as much of conventional medicine that is routinely used in the NHS does not have the RCT evidence that is demanded of complementary therapies, which are less invasive with far less side-effects. We live in a real-world where real world patient experience and outcomes must play a part.

He plays the “real-world” evidence card. This is a clever way to refer to pragmatic and other study designs that are not meant to be efficacy trials. In other words – they are not adequately controlled and therefore cannot (and should not) but used to determine if a treatment works. He therefore wants to use the wrong kind of evidence, less rigorous evidence, which can more easily be manipulated to manufacture the appearance of evidence to support his preferred treatments. This is naked pseudoscience.

He also again tries to make the false-equivalency argument, that mainstream medicine also does not uniformly have high quality RTC evidence behind it. This is an overstatement of the facts, and ignores the real point. Medicine should be based on the best currently available evidence, and appropriately and ethically follows a hierarchy of evidence. Simply because we do not have high quality evidence for every possible decision, that does not mean we can abandon the rules of evidence and use highly implausible treatments that are not backed by quality evidence.

Again, this is a similar intellectual strategy to the creationists, who will pick at details that are not currently understood within evolutionary theory as if this means we can abandon the entire theory, or treat competing ideas as if they were legitimate.

Tredinnick complete the usual set of political arguments for nonsense with this:

Patients are usually more open-minded than many of the doctors who treat them, and we must work to ensure that patients really do have information and choice in our Health Service rather than being given choice, as long as it’s one of the options their doctor or CCG allows them to choose.

The “open minded” gambit is also a common ploy. Being “open minded” is treated as a virtue, identical to way having faith is treated for spiritual belief systems. I have argued that science is the most open minded system humans have developed, for all ideas are treated within (ideally) a pure meritocracy of logic and evidence, and all conclusions are tentative and open to new evidence.

Ironically, it is Tredinnick and his ilk who are being supremely closed minded. He is closed to the evidence which states that homeopathy does not work, and astrology is nothing but superstition. If the current evidence has not already convinced Tredinnick that these modalities do not work, than no amount of evidence ever will – because he is closed-minded to that possibility.

Finally he makes an appeal to choice, which politically is very effective. However, choice does not mean that the government has to endorse and pay for nonsense. Further, the treatments he favors violate patient information and informed consent. I doubt anyone would buy a homeopathic remedy if the package truthfully stated what was inside. Patients can only make free choices if they are given scientifically accurate and thorough information – that is what we advocate, and what Tredinnick and CAM advocates oppose, by spreading misinformation and propaganda regarding their preferred magical and pseudoscientific treatments.

Conclusion

It is difficult to imagine a worse choice for chair of the Health Select Committee than Tredinnick. From what he says and writes he clearly does not understand medical science (and probably science in general) and is profoundly confused by anti-scientific propaganda, which he is now spreading further.